With our President and our own intelligence agencies currently in public disagreement about our greatest threats (Southern border migrants {Tweets} VS China, Russia, and North Korea {“Worldwide Threat Assessment”} ), it seems an appropriate time to list again some of the things that might threaten us from a medical point of view. I last did this on February 1, 2010.

Repeats from 2010:

Watching TV– increase chance of a cardiac death by 18%, increase chance of obesity in children by 5%.

Toys – 13,663 head injuries in children from toys seen in an ER in 2005; 251,000 toy injuries seen in ERs in 2018; 41% (102,910) were injuries of face or head.

Sleep apnea in truck drivers – Sleep apnea increases the chance of a driving accident by about 100%; 17% of truck drivers have sleep apnea

Brain cancer from cell phones– no evidence for it in 2010; “maybe” in 2019; very heavy users over 10 years in Sweden had an increased incidence of acoustic neuroma (non-cancerous growth on hearing nerve).

Contaminated herbal supplements – more studies continue to find supplements with incorrectly labeled ingredients and/or unlabeled contaminants. Most of these supplements are for sexual enhancements, body building, or weight loss.

Vaping of nicotine products – “Unknown risks” noted in August 1, 2009; Still unknown over the long term, but of more concern because of the alarming explosion of use by junior high students and 21% of twelfth-graders.( an increase of 1.3 million teens just since 2017) (NEJM 2018 Dec 17)

New threats:

Gun Violence – I am surprised that this wasn’t in my 2010 list since it seems like we have been talking about this threat for years, but it was before the Sandy Hook and Stoneman Douglas school massacres . Wikipedia has a handy list of 122 world-wide school massacres by country, dates, number killed, etc. Do you remember what the auto industry said in the past regarding proposed laws requiring seat belts? – “Cars don’t kill people; people kill people.” I don’t either. Someone must have made that up to make a point. Check my two previous blogs (2015 and 2018) for the comparison of “the frog sitting in the gradually heating up water” with our pace of achieving gun safety. (“By Degrees”, Markerelli.com)

Climate Change – Extreme weather events and raging wildfires in California have caused some to label climate change as a “Health Emergency”. Accompanying an article describing the stress on emergency medical care resources and the significant contribution to air pollution caused by the California wildfires, a lead editorial in the New England Journal of Medicine stated: “Climate change is already adversely affecting human health and health systems, and projected climate change is expected to alter the geographic range and burden of a variety of climate-sensitive health outcomes and to affect the functioning of public health and health care systems.”

Large Gathering in Any Public Place – During a break in the interminable Boston TV coverage of the Patriots prior to Super Bowl LIII one channel showed a segment on the security planned for the Mercedes Benz Stadium in Atlanta. It was impressive; ten miles of fencing, prohibition of drones, helicopter fly-overs, fully-armed policemen, and more-fully-armed soldiers (always shown walking in pairs). Nothing new to us since September 11th. Just another reminder, but now at least we realize it is not actually foreign “terrorists” that have caused the most havoc in our country.

Enough about threats. Any good news?

Salt-free diet not necessary for heart failure patients- A review of 9 studies showed “a paucity of evidence supporting low-sodium diets for patients with heart failure”. The recommended first step is to “… retreat from an unbridled and potentially harmful insistence on rigorous sodium restriction” in these patients. (JAMA Internal Med 2018 Dec; 178)

Vitamin D supplements of no benefit to preventing cancer or cardiovascular disease –A study of 25,800 participants over 50 years old followed for 5 years showed that daily 2000 IU of Vitamin D “did not keep the doctor away” compared to placebo. This is good news for people spending money on vitamin D supplements for this purpose. (NEJM January 3, 2019:380;1)

Stand-up desks at work reduces sitting times – See “Watching TV” above, but unfortunately there are no studies that standing does anything but improve psychological well being of the worker with some work-related benefits. When arising from the sitting position, the authors recommended doing some physical activity. Standing alone is not any healthier. (BMJ 2018 Oct10:363)

Causes of Deaths of U.S. Children in 2016Firearms-related deaths are #2, just behind motor vehicle crashes. 60 % of the three thousand plus firearms-related deaths were homicides. 35% were suicides. Both motor vehicle and firearms-related deaths percentages have increased every year since 2013. The ratio of causes of firearms-related deaths of adults (over 20 yo.) was the opposite: 62% suicide and 37% homicide. Cancer was #3 at 9% of all children deaths both years.

Continued resistance to gun safety reform legislation has been called “another example of U.S. public health intervention being cast as an attack on individual liberty.”

Driver safety being the other example, of course.

Benefits of Aspirin in Elderly or DiabeticsThree studies published in the New England Journal of Medicine this October showed that daily low dose aspirin provided no benefit to the elderly against all types of deaths, cancer-related deaths, dementia, physical disability, or cardiovascular events. They did reveal an increase in non-fatal significant bleeding events. 3% of those taking the aspirin suffered such an event compared to 2% taking the placebo.

A fourth study published in the same issue appeared to show that low dose aspirin reduced the incidence of non-cardiac vascular events in adults (all ages) with diabetes. The percentages of adverse bleeding events (mostly gastrointestinal) was again 1% higher in those taking the aspirin. In contrast to other studies the use of aspirin did not reduce the incidence of gastrointestinal cancer.

Immigrant Children in DetentionThe latest independent estimate of children held in 9 U.S. centers is 15,000. The Department of Home Security does not publish statistics, and, in fact, is not too sure itself how many they have. There have been two instances when Home Security could not account for 1400-1500 children. Most of the children are held in large centers with up to a thousand children. The length of stay has been from 104 to 240 days. Currently nearly 300 are children whose parents have already been deported, so that their eventual disposition is up for grabs.

The recent deaths of two Guatemalan children in detention (one 7 yo. and the other 8 yo.) remain under investigation, but in reading between the lines I suspect that they were caused by flu-like illnesses in dehydrated, malnourished, and tired kids, i.e. eminently preventable deaths.

More About the Southern Border ImmigrantsThe number of people arrested trying to illegally cross the Mexican border has been decreasing each year since 2005 (President Bush) and is now at the lowest point since 1971. The number of “people in families” arrested monthly during the same period has increased 2.5X from under 10,000 to 25,172 this November. Hence, one reason for the recent development of an “humanitarian crisis”. The number of arrests of “unaccompanied children” has remained the same at about 5,000 per month

The Mexican border is the primary entry point for cocaine, heroin, and methamphetamine which is mostly carried by trucks through official border crossings.

Texas is the only state that has statistics on crimes by immigrants (the federal agencies have none). In 2015 the relative rates of crimes per 100,000 residents in Texas analyzed by the Cato Institute were:

Probiotics for Diarrhea/Effects on Your MicrobiomeTwo recent very large studies in children showed that twice daily doses of a certain probiotic did NOT shorten the duration of diarrhea or reduce the number of bowel movements per day. This is yet another study showing no real benefit from probiotics, but believers point out that maybe they were using the “wrong” probiotic.

In other probiotic news: In contrast, another recent study suggests that probiotics can change a person’s own gut microbiome in such a way to make the person’s gut microbiome LESS protective against illnesses.

The Microbiome and ObesityA study of multi-generational Southeast Asian immigrants showed that soon after arrival in the U.S. the diversity of their gut microbiome began to decrease to the level resembling the less-varied microbiome of European Americans. “Just living in the U.S. reduced their microbiome diversity by 15%.” At the same time their obesity rate spiked! Previous studies indicated that the more diverse gut microbiome in people in less developed countries protected them from developing metabolic diseases like diabetes.

We Are All Getting HeavierIn the U.S. both the average man and the average woman gained 24 pounds from 1960 to 2002. By 2016 men had gained an average of 8 pounds more; women 7 pounds. Both white and black men increased an inch in waist size. White woman increased their waist size by 2 inches; black women reduced theirs by an inch. The average American man is now 5 feet 9 inches, weighs 198 pounds, and has a 40 inch waist. The average American woman is 5 feet 4 inches, weighs 171 pounds, and has a 39 inch waist. Both have a BMI near or at 30, the “high end of overweight.” These results are from actual measurements because “ people tend to overreport their height and underreport their weight.”

Editorial note: Our local YMCA “free sign-up day” on January 1 was mobbed. On January 6 the men’s locker room was quite crowded. Overheard from the next cubicle: “Just wait 3 weeks. There’ll be plenty of room again.” Update in the near future.

Unsafe Toys for Christmas 2018
World Against Toys Causing Harm or W.A.T.C.H. has just released its 5th annual list of “worst toys for the holiday season” picked for their potential cause of choking, eye injury, or other safety hazard. In 2016 there were 240,000 toy-related injuries. During 2014 to 2016 there were 35 toy-related deaths. The top ten worst toys this year include:

Stomp Ultra Rocket – “fires up to 200 ft. in the air if not stopped by an eye”

Lower Your Prostate Cancer Risk by Riding a Bicycle
Men who did long-term vigorous exercise like biking, swimming, or running had a 25-30% less chance of developing advanced or lethal prostatic cancer. Exercise even lowered the risk for those men who have a specific genetic subtype of prostatic cancer seen in half of the deaths. “The influence of insulin, growth factors, and other metabolic factors” is thought to be the link between exercise and the lower risk according to this Harvard School of Public Health study of 49,000 healthy men between 1986 and 2012.

Many Nutritional Supplements Include Contaminants
Half of U.S, adults take some sort of nutritional supplements spending about $30 billion annually, and the FDA is prohibited by law to evaluate supplements for safety or efficacy PRIOR to marketing. The FDA can issue post-marketing warnings about adulterants. One study from 2007 to 2016 identified 776 supplements, mostly for sexual enhancements, weight loss, or muscle building, with either adverse events or consumer complaints,. Of the 28 products that had received two or more “FDA warnings” 19 continued to be sold. In another study of 21 supplements with “FDA warnings” because of one or more unapproved stimulants, 12 were still available in 2007 and 9 of the 12 still contained the same stimulants. Q.E.D.; FDA warnings have little effect in protecting consumers from potentially harmful effects of contaminants in nutritional supplements.

Does Drinking More Water Reduce Bladder Infections in Women? Yes, if they had 3 or more bladder infections in the previous year and are drinking LESS than the recommended 1500 ml. (4 water bottles) a day. If they doubled the amount of water to 3000 ml. (8 water bottles) a day the reoccurrence of a bladder infection is reduced from 3.2 a year to 1.7 a year (at least in Bulgarian women). If they were already drinking over the 1500 ml. minimum a day increasing the amount had no effect on recurrence. [All the U.S. women I know, at least in Barnstable county, take a bottle of water with them when they’re just going to the post office.]

One-half of Obese Adolescents Started Being Overweight When 3 – 5 Years Old (at least in 50,000 healthy German children)
Most of the children who were obese at age 6 were obese as adolescents. Rates of obesity were higher in children with overweight or obese mothers. “It is an ominous sign that the number of American children with the most recalcitrant forms of obesity has increased progressively during the past 10 years.” This study suggests that physicians should start nutritional counseling if exaggerated weight gain occurs after age 2! (NEJM October 4, 2018)

Do Not Use Infant Walkers
Despite the fact that the American Academy of Pediatrics has long called for infant walkers to be banned in the U.S. as they are in Canada, infant walkers are still sold here. An average of 9,000 infants a year under 15 months of age are treated in our ERs with head or neck injuries when infant walkers go down household stairs with an infant in them. The AAP says that “there is no advantage of the walker to the infant and parents should not use them.”

A Chilling Aftermath of Our Latest Gun Violence
A friend of mine has a brother who worships at that Pittsburgh synagogue. He was not there for the October massacre, but sat Shemira (literally a bodyguard) for a member who was. After Shemira the brother called my friend to say that he had bought a gun and obtained a carry permit. My friend was incredulous, and asked him, “When are YOU going to carry a gun?” His brother’s answer, “Only when I pray”.

A Prayer for Our Times
The mid-term elections are over, but the political hyperbole and acrimony, especially from the President to the press, is not. On Veterans’ Day we sang “America the Beautiful” in church, and I was struck by the relevance of the unappreciated second verse:

It is the day after Halloween, so I wanted to write a scary blog, and I couldn’t think of anything scarier than a massacre of 11 praying people by someone with an semi-automatic assault rifle.

The Valentine’s Day Massacre of 1929 (only 7 dead) resulted in a 1934 law restricting the sale, registering the owner (including fingerprints), limiting the transport, and setting up a federal government record of Tommy guns. The whole process of buying a Tommy gun took about 4 months. The law (it was not a ban) worked for Tommy guns. They became too expensive, too scarce, and too much of a hassle to own, and they have disappeared from our everyday life. Maybe that law happened because a majority of people regarded the Chicago mobsters as criminals.

So why not pass effective federal restrictions on the sale and ownership of assault rifles? Let’s acknowledge that people who use them to kill other people are just criminals. Lets stop all the noise and emotional overlay about the shooter’s motives and background. Just call him “a criminal” and restrict access for future criminals to his weapon of choice. Such assault rifle restrictions (not a ban) might, at least, successfully reduce the body count for any one particular future rampage. There are plenty of other kinds of guns around that the mentally deranged, political extremist, terrorist, or even just a ticked-off jilted lover can use, so no one’s constitutional right will be abridged.

On the other hand, the October 2018 Philadelphia synagogue massacre somehow doesn’t seem all that scary. After all, we have had similar massacres in night clubs, Southern churches, rock concerts, movie theaters, and elementary schools. Some of us may have kind of “gotten used to it”. Sort of like that old story of the frog sitting in a pot of water getting hotter and hotter on the stove burner, and the frog, not sensing the heat increase by degrees, just sits there until he is boiled up.

“By Degrees” is a song written by Mark Erelli that relates that “frog in hot water” story to our epidemic of gun violence. Other famous singer-songwriters, Rosanne Cash, Sheryl Crow, Josh Ritter, Lori McKenna, and Anais Mitchell join him in singing it. Gabby Giffords: Courage to Fight Gun Violence is helping to distribute it as a digital copy. You can go to www.bydegreessong.com to download it while you watch a video of the lyrics. All of the $4.69 and any additional money you wish to donate goes directly to the Gabby Giffords fund.

Go to the By Degrees website, and click the “GET THE SONG” button. This will take you to Giffords’ Act Blue donation page, where you can pay any amount you like for the song, and you will immediately receive a thank you email with a link to download the track.

BY DEGREES by Mark Erelli
When I take a look around me sometimes I wish I was blind
Feels like something sacred’s dying, one headline at a time
I can’t tear myself away, no I just stare in disbelief
You can learn to live with anything when it happens by degrees

I’ve seen every head bowed down as if lost in private prayer
I’ve seen the phones in every hand, seen the long and vacant stares of souls gone numb,
thumbing through each ceaseless, changing feed
You can learn to live with anything when it happens by degrees

I’ve seen talking heads shout back and forth across some great divide
Against a map of red and blue, points of view so cut and dried
But when you look into the mirror what color country do you see?
Where you can learn to live with anything when it happens by degrees

I’ve seen the flags at half-staff as the nation mourned and moaned
I’ve seen the stars and bars a-flyin’ proud above the state house dome
For the Charleston nine we sing “I once was blind, but now I see”
We can learn to live with anything when it happens by degrees

I’ve seen little hands on little shoulders, children in a line
I’ve seen them led away from school as the shots rang out inside
And I thought something had to change but somehow it’s become routine
We can learn to live with anything when it happens by degrees

I’ve seen sadness seep into my heart, each day a little more
This darkness growing so familiar, I can’t recall what came before
My children’s faces filled with questions, looking up expectantly
And I don’t know what to tell them
I can’t bring myself to tell them
That you can learn to live with anything when it happens by degrees.

As Mark says, “I am under no illusions that my song will solve the problem of gun violence. But I have seen what doing nothing does and want to do something. I’m a songwriter and musician, so I did the only thing I knew how to do, as good as I could do it. I appreciate your support and urge you do what you can to support the cause against gun violence.